Ultrasound in spontaneous cervical artery dissection

Abstract

Spontaneous cervical artery dissection is caused by a hematoma in the arterial wall. Recent research revealed that the most likely pathophysiological key mechanism is rupture of a vas vasorum resulting in a bleeding into the medio-adventitial borderzone [1]. The expansion of the hematoma into the arterial lumen can secondarily lead to a rupture of the tunica intima with a high risk of thrombus formation and embolic cerebral infarction [2]. Moreover the expansion of the hematoma causes an arterial stenosis or arterial occlusion with the risk of hemodynamic impairment. The risk of an ischemic stroke in the course of a dissection is thought to be about 70% for dissections of the internal carotid artery (ICA) [3] and about 80% for dissections of the vertebral artery (VA) [4]. The annual incidence of dissections of the ICA has been estimated to be 2.5–3/100,000 and for the VA 0.97–1.5/100,000 [5], [6]. Although dissections as such are rare they are a frequent etiology of stroke in children and young adults. Approximately 25% of the strokes in patients younger than 50 are caused by dissections with a peak age between 40 and 45 years [7], [8], [9], [10], [11], [12], [13], [14], [15], [16].